Comparison of Motion Changes and Clinical Outcomes between Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion in Single Level Cervical Degenerative Disease: Retrospective Analysis

Objective: Cervical Total Disc Replacement (CTDR) has recently been developed as an alternative to Anterior Cervical Discectomy and Fusion (ACDF) in cervical degenerative disease to preserve the motion at the treated level. The aim of this study is to investigate the safety and efficacy of CTDR by comparing it with ACDF in the treatment of single-level cervical degenerative disease, retrospectively. Methods: This study included 61 patients, who underwent either stand-alone single-level ACDF (n = 33) or singlelevel CTDR (Bryan cervical artificial disc, n = 28) at C3 to C7 for degenerative cervical disease between June 2007 and December 2009. Cervical radiographs were obtained to measure overall and regional cervical angle and Range of Motion (ROM). For evaluation for patient’s pain, visual analogue scale and Japanese Orthopedic Association score was measured. Results: The changes of the overall Cervical Sagittal Angle (CSA) were not significantly different between the two groups. The Segmental Angle (SA) was maintained at a significantly higher in the CTDR group compared to the ACDF group during the follow-up period (p < 0.05). The ROM of the upper adjacent segment was significantly increased in the ACDF group compared to the CTDR group. Conclusions: Clinically, CTDR is at least as efficient as ACDF. CTDR using a Bryan artificial disc provided a significant maintenance of the SA and the ROM at the treated level, and prevented the hyper-mobility at the upper adjacent segment compared to the ACDF. In the Future, prospective, randomized, long-term follow-up study with large-number will be required to clarify the efficacy of CTDR. *Corresponding author: Jung-Kil Lee, Department of Neurosurgery, Chonnam National University Hospital 671, Jebongno, Dong-gu, Gwangju, 501-757, Republic of Korea, Tel: 82-62-220-6602; Fax: 82-62-224-9865; E-mail: [email protected] Received March 29, 2012; Accepted April 20, 2012; Published April 23, 2012 Citation: Kim SD, Lee JK, Jang JW, Moon HS, Kim SH, et al. (2012) Comparison of Motion Changes and Clinical Outcomes between Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion in Single Level Cervical Degenerative Disease: Retrospective Analysis. J Spine 1:116. doi:10.4172/2165-7939.1000116 Copyright: © 2012 Kim SD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Since Anterior Cervical Discectomy and Fusion (ACDF) was first introduced by Smith and Robinson, since then it has been considered the standard surgical procedure for treatment of degenerative cervical disease [1,2]. The goals of ACDF are to decompress the neural structures including spinal cord and nerve roots and, to provide permanent stabilization via optimal bone fusion of an index level while maintaining cervical physiologic alignment. In literatures, ACDF has provided a greater than 90% likelihood of relieving radicular symptoms and improving myelopathy [2]. However, the cervical spine is a mobile complex, ACDF results in a loss of mobility at the treated level, and it may eventually lead to kinematic strain on adjacent spinal levels and consequent disc degeneration and mechanical instability. Long term follow-up on ACDF has revealed that up to 25% of patients may develop recurrent axial or radicular symptoms for Adjacent Segment Degeneration (ASD) [3]. Furthermore, complications of ACDF, such as graft collapse, expulsion, pseudoarthrosis and instrumentation failure, have been frequently reported during the follow-up period [4]. These problems have encouraged the development of new technology as an alternative to ACDF in cervical degenerative disease; therefore, Cervical Total Disc Replacement (CTDR) has been devised and used now. CTDR was first attempted by Fernstorm [5] and involved the placement of metallic ball bearings into the disc space of the operated segment. However, the clinical trial failed due to a high incidence of endplate subsidence and segmental hypermobility. The era of CTDR has again begun in Europe in the late 1990s, when a renewal of efforts was spurred by progress in lumbar total disc replacement with Charite artificial disc [6]. CTDR offers a theoretical advantage over ACDF in selected patients with medically refractory cervical radiculopathy or myelopathy. By preserving motion at the operated level, CTDR has the potential to decrease the occurrence of ASD. Therefore, studies about Range of Motion (ROM) and cervical sagittal balance after CTDR or ACDF are an essential component, because the maintenance of cervical ROM and alignment after surgery may influence the development of ASD and a patient’s clinical outcomes including physical activity. Recently, the author has performed CTDR for the treatment of cervical degenerative disease. To determine the efficacy and safety of CTDR in cervical degenerative, the author conducted a comparative study regarding cervical alignment, motion changes, development of ASD, and clinical results between CTDR and ACDF groups. In this study, the hypothesized were that CTDR may eventually provide motion preservation on treated level and good overall cervical lordosis, decrease hypermobility on an adjacent level, less development of ASD, and eventually serve favorable clinical outcome compared to ACDF. Therefore, CTDR may be a safe and effective alternative to the traditional ACDF in degenerative cervical disease. Citation: Kim SD, Lee JK, Jang JW, Moon HS, Kim SH, et al. (2012) Comparison of Motion Changes and Clinical Outcomes between Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion in Single Level Cervical Degenerative Disease: Retrospective Analysis. J Spine 1:116. doi:10.4172/2165-7939.1000116